前列腺癌患者全血锌浓度的改变及诊断价值

The Changes in the Whole Blood Zinc Concentration in Patients with Prostate Carcinoma and the Corresponding Diagnostic Value

目的:研究全血锌浓度与前列腺癌的关系,并将其与血清前列腺特异性抗原(PSA)联合,探讨在前列腺癌诊断中的应用价值。方法:收集自2005年7月至2008年10月东南大学附属中大医院和南京大学医学院附属鼓楼医院收治的前列腺癌患者95例,前列腺增生症患者91例,采用火焰吸收原子分光光度法测定全血锌浓度,釆用放射免疫法测定血清PSA值。结果:全血锌浓度前列腺癌组(4.73±1.51) μg/mL,前列腺增生症组(6.82±1.63) μg/mL,两组间有显著差异(P<0.001)。两组血清PSA值总体分布有显著差异(P<0.01),但在4.0～10.0ng/mL区间,两组例数比例无显著差异(P=0.143)。以前列腺增生症组为对照,全血锌浓度诊断前列腺癌的ROC曲线下面积为0.82;在血清PSA 4.0～10.0ng/mL区间范围,此曲线下面积为0.79。在血清PSA 4.0～10.0ng/mL区间范围,全血锌浓度取5.24μg/mL为界值时有最佳的诊断准确性,Youden指数为0.46;其与血清PSA取界值4.0ng/mL串联应用,诊断的特异度为75%,是血清PSA单独诊断时的2.34倍,Youden指数为0.51,是血清PSA单独诊断的2.22倍,并联无助于诊断,Youden指数仅0.14。结论:全血锌浓度检测有助于前列腺癌与前列腺增生症的鉴别诊断,其与血清PSA联合应用(串联),能够显著改善血清PSA 4.0～1 0.0ng/mL区间内的诊断阳性率,可为前列腺癌的诊断提供有价值的参考,有一定的临床应用前景。

Objective： To study the relationship between the whole blood zinc concentration and prostate carcinoma and to explore the diagnostic value of the whole blood zinc concentration combined with blood serum prostate specific antigen （PSA） for prostate cancer. Methods： A total of 95 patients with prostate carcinoma and 91 patients with benign prostate hyperplasia were selected between July 2005 and October 2008 in Zhongda Hospital of Southeast University and The Affiliated Drum Tower Hospital of Nanjing University Medical School. The whole blood zinc concentration was analyzed by atomic absorption spectometry. The serum PSA was analyzed by radioimmunoassay. Results： The volumes of the whole blood zinc concentration were 4.73± 1.51μg/mL in the prostate carcinoma group and 6.82± 1.63 pg/mL in the benign prostate hyperplasia group, with a significant difference between the two groups （P=〈0.001）. The serum PSA general distribution was significantly different between the two groups （P〈0.01）. There was no significant difference in the serum PSA of 4.0 to 10.0 ng/MI between the two groups （P=-0.14）. Compared with that in the benign prostate hyperplasia group, the area under ROC curve for the whole blood zinc concentration in the prostate carcinoma group was 0.82. The diagnostic accuracy was optimal with 5.24μg/mL set as the cut-off value of the whole blood zinc concentration and the Youden＇ s index was 0.46 when it was combined with serum PSA 4.0 ng/mL （connection in series）. The specificity was 75%, up to 2.34 times of serum PSA applied alone. Meanwhile, the Youden＇s index was 0.51, achieving 2.22 times. It was not helpful for the diagnosis of prostate carcinoma that the two diagnostic tools were in parallel by which the Youden＇ s index was only 0.14. Conclusion： Detection of the whole blood zinc concentration is beneficial for differentiation of prostate carcinoma from benign prostate hyperplasia. Combined with serum PSA （connection in series）, it can significantly impove diagnostic efficiency when PSA was 4.0- 10.0ng/mL. Detection of the whole blood zinc concentration can provide valuable information for the diagnosis of prostate cancer and worths clincal application.